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Risk of hospitalisation after early-revisit in the emergency department
Giorgio Cozzi1, Sergio Ghirardo2, Ilaria Fiorese2
1Emergency Department, Institute for Maternal and Child Health IRCCS 'Burlo Garofolo', Trieste, Italy.
Insights
Children revisited within 72 hours to the paediatric emergency department (ED) show a higher hospitalisation risk. This increased risk was not always linked to their initial clinical severity.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Epidemiology
Background:
- Early revisits to the paediatric emergency department (ED) are common.
- Limited data exist on the characteristics and outcomes of these early-revisited patients.
Purpose of the Study:
- To determine the hospitalisation rate of paediatric patients who revisit the ED within 72 hours.
- To assess if early-revisited patients face a higher risk of severe disease.
Main Methods:
- Retrospective cohort study of paediatric ED visits in an Italian tertiary children's hospital (June 2014-January 2015).
- Comparison of patients with unplanned revisits within 72 hours (study cohort) against other patients (control cohort).
- Analysis included age, gender, triage, hospitalisation rate, diagnosis, and length of stay.
Main Results:
- 4% (430/10,750) of visits were unplanned revisits within 72 hours.
- Hospitalisation rate was significantly higher in early-revisited patients (8.4%) compared to controls (2.9%).
- Increased revisit frequency correlated with higher hospitalisation rates, but not always with worse triage or longer stays.
Conclusions:
- Paediatric patients with early revisits to the ED have a significantly elevated risk of hospitalisation.
- This increased hospitalisation risk is only partially explained by the patients' clinical conditions upon revisit.
Aim:
Early-revisits are frequent in the paediatric emergency department (ED) setting, but few data are available about early-revisited patients. The aim of this study was to investigate the hospitalisation rate of a population of early-revisited patients and to detect if an early-revisited patient was at risk of a more severe disease.
Methods:
Between June 2014 and January 2015, we conducted a retrospective cohort study, considering all patients presented to the ED of a tertiary level children's hospital in Italy. We selected all patients who were revisited within 72 h from the initial visit (study cohort), while all other patients accessed in the same period were considered the control cohort. The two cohorts were compared for age, gender, triage category, hospitalisation rate, diagnosis at admission and hospital length of stay.
Results:
In the study period, we reviewed 10 750 visits, of which 430 (4%) were unplanned revisits for the same chief complaint within 72 h from the initial visit. Hospitalisation rate of early-revisited patients was significantly higher compared to control patients (8.4 vs. 2.9%). Hospitalisation rate increases in parallel with the number of revisits, but in many cases, it was not directly related to a worst triage category, neither to a longer hospital length of stay.
Conclusion:
Early revisited patients in the ED had a significantly higher risk of hospitalisation, but this risk was only partially related to their clinical conditions.
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